NPIMap

Organization Active NPI

Prohealth Select, Inc.

  • Nurse Practitioner
  • Boca Raton, FL
National Provider Identifier
1417485053
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PROHEALTH SELECT, INC.
Practice address
621 NW 53Rd St Ste 330
Boca Raton, FL 33487-8281
Phone
(800) 488-0279
Fax
(866) 902-8817
NPI assigned
May 26, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nancy Bourg
Title
Ceo
Phone
(800) 488-0279

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Physician Assistant 363A00000X FL
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X
Nurse Practitioner 363L00000X FL Primary

Addresses

Primary practice location

621 NW 53Rd St Ste 330
Boca Raton, FL 33487-8281

Mailing address

621 NW 53Rd St Ste 330
Boca Raton, FL 33487-8281
Phone (800) 488-0279

Other names 1

  • ProHealth Select, Inc Other name

National Provider Directory

National Provider Directory

Locations

621 NW 53rd St
Ste 330
Boca Raton, FL 33487
Phone (561) 440-7617

5500 Military Trl
Ste 22324
Jupiter, FL 33458
Phone (561) 440-7617

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1417485053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 NW 53RD ST STE 330",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334878281",
            "telephone_number": "800-488-0279",
            "fax_number": "866-902-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 NW 53RD ST STE 330",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334878281",
            "telephone_number": "800-488-0279",
            "fax_number": "866-902-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH SELECT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-26",
        "last_updated": "2022-07-21",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "BOURG",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-488-0279"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProHealth Select, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.